The increasing burden of inflammatory bowel disease

Edward V Loftus
Med J Aust 2021; 214 (8): . || doi: 10.5694/mja2.51001
Published online: 3 May 2021

Until we reach “prevalence equilibrium”, even small increases in incidence eventually result in higher prevalence

When I attended medical school in the 1980s, we were taught that ulcerative colitis and Crohn disease were conditions seen in white people in highly developed regions such as northern Europe, the United Kingdom and some Commonwealth nations, and North America. Over the past four decades, the incidence of inflammatory bowel disease (IBD) across geographic regions and ethnic groups has risen sharply.1 The global burden of IBD, which can substantially reduce quality of life, is clearly increasing.2 Patients with IBD often require expensive medications or procedures,3 have higher rates of anxiety and depression,4 and are more likely to have disabilities.5

  • Mayo Clinic, Rochester, MN, United States of America


Competing interests:

I have provided consultation services to AbbVie, Amgen, Allergan, Boehringer Ingelheim, Bristol‐Myers Squibb, Celgene, Celltrion Healthcare, Eli Lilly, Genentech, Gilead, Iterative Scopes, Janssen, Ono Pharma, Pfizer, Takeda, and UCB. I have received research support from AbbVie, Amgen, Bristol‐Myers Squibb, Celgene, Genentech, Gilead, Janssen, Pfizer, Receptos, Robarts Clinical Trials, Takeda, and UCB. I am a shareholder in Exact Sciences.

  • 1. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2017; 390: 2769–2778.
  • 2. GBD 2017 Inflammatory Bowel Disease Collaborators. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5: 17-30.
  • 3. Park KT, Ehrlich OG, Allen JI, et al. The cost of inflammatory bowel disease: an initiative from the Crohn’s & Colitis Foundation. Inflamm Bowel Dis 2020; 26: 1–10.
  • 4. Szigethy EM, Allen JI, Reiss M, et al. White paper AGA: the impact of mental and psychosocial factors on the care of patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2017; 15: 986–997.
  • 5. Lo B, Prosberg MV, Gluud LL, et al. Systematic review and meta-analysis: assessment of factors affecting disability in inflammatory bowel disease and the reliability of the inflammatory bowel disease disability index. Aliment Pharmacol Ther 2018; 47: 6–15.
  • 6. Freeman J, Hutchison GB. Prevalence, incidence and duration. Am J Epidemiol 1980; 112: 707–723.
  • 7. Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV. Incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol 2017; 15: 857–863.
  • 8. Aniwan S, Harmsen WS, Tremaine WJ, et al. Overall and cause-specific mortality of inflammatory bowel disease in Olmsted County, Minnesota, from 1970 through 2016. Mayo Clin Proc 2018; 93: 1415–1422.
  • 9. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol 2015; 12: 720–727.
  • 10. Kaplan GG, Bernstein CN, Coward S, et al. The impact of inflammatory bowel disease in Canada 2018: epidemiology. J Can Assoc Gastroenterol 2019; 2(Suppl 1): S6–S16.
  • 11. Jones GR, Lyons M, Plevris N, et al. IBD prevalence in Lothian, Scotland, derived by capture-recapture methodology. Gut 2019; 68: 1953–1960.
  • 12. Pudipeddi A, Liu J, Kariyawasam V, et al. High prevalence of Crohn disease and ulcerative colitis among older people in Sydney. Med J Aust 2021; 214: 365–370.
  • 13. Mahid SS, Minor KS, Soto RE, et al. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc 2006; 81: 1462–1471.
  • 14. Peppercorn MA. The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 2004; 38(Suppl 1): S8–S10.
  • 15. Thia KT, Loftus EV, Sandborn WJ, Yang SK. An update on the epidemiology of inflammatory bowel disease in Asia. Am J Gastroenterol 2008; 103: 3167–3182.
  • 16. Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and Colitis Epidemiology Study. Gastroenterology 2013; 145: 158–165.
  • 17. Charpentier C, Salleron J, Savoye G, et al. Natural history of elderly-onset of inflammatory bowel disease: a population-based cohort study. Gut 2014; 63: 423–432.
  • 18. Piovani D, Danese S, Peyrin-Biroulet L, et al. Systematic review with meta-analysis: biologics and risk of infection or cancer in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther 2020; 51: 820–830.
  • 19. Nguyen GC, Targownik LE, Singh H, et al. The impact of inflammatory bowel disease in Canada 2018: IBD in seniors. J Can Assoc Gastroenterol 2109; 2(Suppl 1): S68-S72.
  • 20. Kochar B, Cai W, Cagan A, Ananthakrishnan AN. Pretreatment frailty is independently associated with increased risk of infections after immunosuppression in patients with inflammatory bowel diseases. Gastroenterology 2020; 158: 2104–2111.
  • 21. Qian AS, Nguyen NH, Elia J, et al. Frailty is independently associated with mortality and readmission in hospitalized patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2020; [online ahead of print].
  • 22. Kaplan GG, Windsor JW. The four epidemiological stages of the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2021; 18: 56–66.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.